The Wounds Within: a Veteran, a PTSD Therapist, and a Nation Unprepared

I wish the story didn’t sound so familiar.

On June 22, 2004, Marine Lance Cpl. Jeff Lucey used a hose to hang himself in the basement of his house in Belchertown, Mass. Surrounding him lay a semi-circle of photographs. In the center was Jeff Lucey’s platoon group photo from his deployment to Iraq.
One year earlier, as a Marine Reserve truck driver in Nasiriyah, Jeff’s orders had been clear: Don’t stop the convoy, not for anything. Fighting was intense in that part of Iraq, and stopping the convoy could put Marines’ lives in danger. A sergeant in Jeff’s unit told reporters, “The convoy commanders were explicit. ‘Hit ‘em. Crush ‘em.’” They received close SCUD missile fire. The 20-year-old saw dead Iraqis.
The authors of The Wounds Within, psychotherapist Mark Nickerson and professor Joshua Goldstein, chronicle Jeff’s heartbreaking decline after he returned from Iraq. He withdrew, drank more, and had episodes of angry outbursts. But he was reluctant to seek help. Part of this story’s tragedy is the stigma associated with PTSD. Jeff didn’t want to jeopardize his dream of becoming a Mass. state trooper, so he refused the treatment that could have saved his life, until it was too late.
The opening chapters relay the story of his family’s agonizing efforts to help. The book also unflinchingly shows multiple failed intervention attempts and missed opportunities – the family’s, the Marine Corps’ (Jeff self-identified as having symptoms and was still discharged), the Veterans’ Administration’s (they turned him away even after he’d threatened suicide because he’d been drinking), and the therapist’s. But something rises from the ashes. The Wounds Within begins with tragedy and ends with hope. Not rainbow-colored, positive-thinking hope; this is smart, well-documented hope. The author is a leader in the field of treating post-traumatic stress disorder in veterans. Adding to the credibility, 83 footnotes reference key books, media stories and academic articles related to PTSD treatment.
The Wounds Within may feel like two books. After the tragedy, which filmmaker Oliver Stone rightly calls “a powerful family drama,” comes a series of insights about deployment which rings true on every page. If you’ve deployed, or know someone who has – and after 14 years of war you probably do – then this book will help you understand the combat veteran in your life. For example, the section on “hyperarousal” explains why your war vet friend avoids crowds and sits at a restaurant with his back to the wall. The discussion of “intrusions” helps explain why your spouse breaks out in a sweat at the sound of a door slamming, or how the smell of diesel exhaust triggers a flashback.
The authors coin a phrase that says the job isn’t over when vet’s redeploy: they’re entering the home zone. Veterans received hours of training before entering the war zone; much less before returning home. Nickerson writes, “…skills that work well in a war zone can create problems in the home zone.”
The book also chronicles a common reaction of returning war vets - impatience with civilian concerns about what they see as trivial matters of everyday life. In one transformative section, the authors recognize that even given the problems associated with combat-zone deployments, “many veterans have a counterbalancing strength—the resilience they have developed in tough conditions. The veteran can come back stronger, wiser, and more compassionate.”
With the right support, negative traits can be diminished -- and must be, because more than one life is riding on the veteran’s healing. “When a vet has PTSD,” Nickerson said at a reading, “the whole family has PTSD.” He mentions a second wave of uncounted casualties – family members and loved ones.
Full disclosure: Last year, acting on a friend’s urging, I heard Mark Nickerson read at the Clapp Memorial Library in Belchertown, the town where Jeff Lucey grew up, a few months after I returned from Afghanistan. While Jeff Lucey's father sat to the side of the crowd, Nickerson told Jeff’s story and explained effective healing strategies.
Nickerson noted the "lag time" between returning home and PTSD onset. "During a trauma, part of you seizes up and locks away memories of the event," he said. Then something opens up those memories: a loud noise, the smell of dust, a dream. Symptoms vary, he told the crowd, but there are some “hallmarks of PTSD.” At first, you're happy to be back, so PTSD doesn't set in right away. But at some point the classic signs appear: intrusive memories or emotions, being amped up and hyper-vigilant, depression, which he said is the body's defense against being too anxious.
Numerous questions from audience members focused on the theme of how do I get my friend, son, nephew, grandson, to go to counseling? It's tragically routine for veterans not to seek counseling because of the perception (and often reality) of mental-health issues being a career-killer, he said. Additionally, "people in military service are by nature helpers," he said, and not inclined to seek help. They are the strong ones, not the ones needing care.
After the library talk, I read his book. It was unlike anything I’d read about how PTSD works. It felt great to read that PTSD didn’t have to be a life sentence. Indeed, Nickerson titles a seminal chapter, “Full Recovery: Treating PTSD.”
The authors debunk the extreme notions of veterans as either superheroes or damaged goods. Then they dig into the hard and good work it takes to heal. People think that working with a compassionate counselor is enough to make therapy work, they write, but research shows that in addition to being an empathic listener, “the therapist must have trauma-specific skills and training for successful PTSD treatment.”
Nickerson urges people with PTSD to approach their own healing as seriously as they prepared for war. Combine proven healing methods such as education about how PTSD works, relaxation techniques, group or family therapy, medications, and psychotherapy.
The VA and DOD guidelines say evidence shows that four psychotherapy treatments are most effective.
For exposure-based therapies, the vet returns to harsh memories and re-process thoughts about the event(s).
Cognitive-based therapies work to change thoughts and actions connected to the event(s).
Stress-inoculation training combines recalling the traumatic event with relaxation techniques.
The method of psychotherapy Nickerson uses is called Eye Movement Desensitization, which uses alternating eye movements, similar to what you’d experience during REM sleep, to reprocess and take the sting out of bad memories.
The authors define what it means to “reprocess” a traumatic memory: vets recall the memory, stare hard at the trauma with adult eyes in a safe environment, and come away with the memory in its proper place – as a memory that no longer controls current behavior or has the power to push them into “trauma mode.”
Since Nickerson uses EMDR therapy, he spends more time explaining that treatment. The results are impressive. “One study on EMDR treatment for combat veterans with multiple experiences of traumatic stress reported that twelve treatment sessions resulted in a 77 percent elimination of PTSD.” In another study, combat vets’ symptoms dropped from severe to mild in just eight sessions for vets with physical wounds. Veterans with no injuries saw marked improvement in four sessions. This flies in the face of the Vietnam-era belief that PTSD is just something you live with. It’s a profoundly hopeful message, and reason enough to encourage vets to seek help.

Editor’s note: The opinions in this review are the author’s own, and do not indicate endorsement or necessarily reflect the opinions of the DOD or U.S. Air Force.